The effect of CPAP ventilation masks on dento-facial development in paediatric patients with developmental hypoventilation. A case series.

Barr, C.; Carter, L.; Krishnan, O.; Jawad, Z.

The effect of CPAP ventilation masks on dento-facial development in paediatric patients with developmental hypoventilation. A case series.

All Authors

Barr, C.

Carter, L.

Krishnan, O.

Jawad, Z.

LTHT Author

Barr, Christopher
Carter, Lachlan
Krishnan, Ojas
Jawad, Zynab

LTHT Department

Doctors' Rotation
Leeds Dental Institute
Oral & Maxillofacial Surgery
Orthognathic Craniofacial Service

Publication Date

2024

Item Type

Conference Abstract

Abstract

Objectives: A case series of patients with hypoventilation from developmental causes to describe the impact of assisted ventilation on dentofacial development and the multidisciplinary approach to management of these patients. Material(s) and Method(s): This case series includes two patients with congenital central hypoventilation syndrome (CCHS) and one patient with Crouzon syndrome. Specific facial phenotypes have been described for both CCHS and Crouzon syndrome. We aim to describe the craniomaxillofacial, paediatric and orthognathic management of the cases and specifically where CPAP mask use has affected dentofacial development and subsequent orthognathic/orthofacial distraction treatment. Both CCHS patients were prescribed the use of a full facemask initially followed by a central facemask covering the nose and up to the chin whereas the Crouzon syndrome patient had only a central facemask. Result(s): These cases highlighted an emerging pseudo-class III skeletal profile with mid face hypoplasia and disproportionate growth of the chin point compared to the mandibular alveolus. This is different to the previously described facial phenotypes in CCHS and Crouzon syndrome. We noted the pressure build up in the oral cavity from CPAP mask use also causes a distinct retroclination of the mandibular teeth with crowding. We suggest monitoring of facial growth in a combined cranio-maxillofacial orthodontic clinic with the consideration of interceptive treatment using a functional appliance. Conclusion(s): Although there are specific facial phenotypes of patients presenting with CCHS and Crouzon syndrome, we aim to make clinicians aware of the considerable dento-facial sequelae of CPAP mask treatment. The retrusive forces to the midface from CPAP masks can have significant effects for growth and monitoring for such development should inform discussions regarding appropriate ventilatory strategies and interceptive craniomaxillofacial and orthodontic treatment.